Doctor, you’ve got to fix Maggie!

Tim Gieseke MD, CMD

How often have you received this call from a facility nurse after a patient with dementia has hurt a staff member or another resident?  As I reflect back on my long career in older adult medicine, the focus of my training, and of the nurses in all settings of care has been on controlling dementia problem behaviors with drugs.  In a sense, nurses, NPs, PAs, and physicians have focused on a medication response during a crisis and have not reflected enough on how to minimize their development.  

For a person with dementia, the institutional world of Post-Acute, Nursing Home, and RCFE care can be overly restrictive, generic, and confusing.  In a sense, this can be a perfect formula for generating problem behaviors.  How often do we recognize triggers with escalating confusion, anxiety, and anger?  How well do we understand the neurobiology of dementia with predictable disabilities and yet retained capabilities?  How well do we contextualize this information to what we should know about the past life of persons with dementia?  How does our care plan reflect this information and how does our staff implement these plans?  These are important questions that should be addressed for each of our persons with dementia. 

To do this, we need new skills and training.  Realizing this, I recently spent a whole day workshop on non-pharmacologic care of persons with dementia at the just completed annual 2015 AMDA meeting in Louisville, Kentucky.  As a physician with medication expertise in the care of persons with mental health and dementia disorders, I can now enthusiastically embrace better ways of preventing and alleviating the distress we so commonly see in persons with these medical problems.  At this workshop, we had real-time coaching by Teepa Snow of the “Positive Approach” to dementia care.  She is an advisor to CMS on dementia care who is a wonderful teacher.  You can easily find some YouTube formatted training material by Googling “Teepa Snow”.

For this type of care to become a reality in your facilities I recommend more thoughtful training on dementia care.  As chair of education at CALTCM, I highly commend the upcoming dementia training pre-conference workshop on this subject on April 24 at our 2015 Annual Meeting in Los Angeles.  

Remember, our patients, their families, and our staff will all benefit from this “Positive Approach”.

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